Insertional Achilles tendinopathy, also known as tendonitis, tendinosis, or paratendonitis, is a condition characterized by the degeneration or breakdown of the Achilles tendon over time. This tendon, which connects the calf muscle to the heel bone (calcaneus) along the back of the leg, is affected at its attachment point to the heel bone.
Symptoms
Patients typically experience a gradual onset of pain and swelling at the back of the heel bone without a specific injury. Initially, the pain may only manifest after activity but can worsen with time. Sometimes, the pain seems to arise suddenly. Activities such as jumping, running, or uphill walking exacerbate the discomfort. Swelling or enlargement of the heel area may occur, leading to painful friction within shoes. Tendon stretching is often painful, and the affected area may be tender to touch.
Causes
Insertional Achilles tendinopathy results from repetitive activity over an extended period, leading to tendon damage at its insertion point. It is frequently observed in runners. Contributing factors may include advanced age, diabetes, obesity, steroid usage, alterations in training, or inappropriate footwear.
Diagnosis
Dr. Kamel conducts a clinical examination to diagnose insertional Achilles tendinosis. X-rays may be ordered to detect calcium deposits within the tendon or heel spurs. While MRIs can assess the severity of tendon damage, they are not mandatory for diagnosis.
Treatments
Non-surgical Treatment
Non-surgical options encompass nonsteroidal anti-inflammatory drugs (NSAIDs), heel lifts, and switching to footwear that alleviates pressure on the affected area. Physical therapy, focusing on tendon-strengthening exercises, is often the primary treatment. However, some stretching exercises may exacerbate pain, hence consultation with a physical therapist is advised. Additional aids such as night splints, extracorporeal shock wave therapy (ESWT), or temporary braces may benefit patients experiencing difficulty walking. Steroid/cortisone injections are discouraged due to the risk of tendon tears. Platelet-rich plasma (PRP) Injections remain of uncertain effectiveness but pose low risk. Platelet-rich plasma involves the use of blood taken from you and separating a part of it that has growth factors or substances that can help your tendon to heal. These growth factors are then directly injected into the area of pain.
Surgical Treatment
Surgery is recommended for patients who fail to respond to non-surgical interventions after 3-6 months. The most common surgical procedure involves removing the diseased portion of the tendon through an incision at the back of the heel. In severe cases, a tendon transfer may be necessary. Post-surgery, patients typically wear a splint or cast boot, with weight-bearing restrictions for 6-8 weeks. Full recovery may take 9 months or longer.
Risks and Complications
Potential complications of surgery include those associated with anesthesia, infection, nerve damage, bleeding, and blood clots. Continued pain in the operated area is the most common complication.
FAQs
How do you treat Achilles tendinopathy?
Rest, ice, aggravating activity reduction, physical therapy (stretching/strengthening), support footwear, orthotics or heel lifts, and medical devices such as shockwave or injections as necessary. In some cases, the severity of Achilles tendinopathy may require surgical intervention.
Is walking good for Achilles tendinopathy?
Yes—light walking will keep the body in shape; do not walk up the hill or on hard surfaces. Progressively resume activity with pain to the degree it permits, with an emphasis on stretching and strengthening.
Is Achilles tendinopathy serious?
Chronic: this may be severe; the tendon can become weak, thick, and degenerated, restricting movement and raising the risk of injury. Early intervention prevents complications and advancement.
What happens if tendinopathy is left untreated?
Untreated tendinopathy could result in chronic pain, tendon degeneration, tendon loss of strength, diminished activity tolerance, and tendon rupture. Early intervention enhances performance.
How serious is Achilles tendon rupture?
A rupture of the Achilles tendon is a major type of injury that might result in severe limitations of walking and push-off strength; it typically needs medical attention, and it may take several months to recover with appropriate treatment.
Can you still walk with Achilles tendon rupture?
Others are capable of walking with a ruptured Achilles tendon, which is painful and unsteady. The doctor typically restricts and advises weight-bearing early in life.
Can flat feet cause posterior tibial tendonitis?
Yes—flat feet put more stress on the posterior tibial tendon, which is overused, inflamed, and dysfunctional in the effort to hold a collapsing arch.
How do you treat posterior tibial tendon dysfunction?
The treatment involves rest, ice, support of the feet (orthotics/braces), physical therapy to make the foot muscles strong, and a change of activities. In severe or chronic cases, immobilization or surgery may be necessary.
What does posterior tibial tendon dysfunction feel like?
The symptoms typically include pain, tenderness in the inner ankle and arch, swelling, weakness, difficulty standing on tiptoes, and occasionally flattening of the arch over time.
